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KIFFO <br /> LLCSAMPLE RECEIPT CHECKLIST SRc#:/ <br /> Sample Receipt Initials/Date: d1/3 Storage Time: 1f7 1O Sample Login Initials/Date: 049< �3 <br /> TAT: Standard ❑ Rush ❑ Split ❑ None Method of Receipt: ❑ Courier Over-the-counter ❑ Shipped <br /> Tem °C N/A Therm ID (e" Time �l :� Coolant present Yes No n Water Ternp Excursion <br /> For Shipments Only: Cooler Receipt Initials/Date/Time: -Custody Seals N/A Intact Broken <br /> Chain-of-Custody: Yes No Documented on COC Labels Discrepancies: <br /> Is COC resent? Sample ID V <br /> Is COC signed by relin uisher? Project ID V <br /> VII <br /> Is COC dated by relinquisher? Sample Date <br /> Is the sampler's name on the COC? Sample Time <br /> Are there analyses or hold for all samples? Does COC match project history? N/A Yes No <br /> Samples: NIA Yes No Comments: <br /> Are sample custody seals intact? e&7 iC iS s ecC �f �,��" / 4 QCD�� , , ►�'� <br /> Are sample containers intact? �►4 k.kD�ei`✓� +�Dltis' A4eK <br /> Is preservation documented? ` <br /> In-house Analysis: NIA Yes No <br /> Are preservatives acce table? <br /> Are samples within holding time? <br /> Are sample container types correct? <br /> Is there adequate sample volume? <br /> Receipt Details: <br /> Matrix Container Type # of Containers <br /> Z CS Required: <br /> Proceed With Analysis: [ YES ❑ NO Init/Date: D-L,w0-17-13i3 <br /> ­4 Client Communication: <br /> Cn <br /> 0 <br /> 0, <br /> O:lold edlsampreclFormslSample Receipt Checklist rev 070113 doc <br />